Uterine Fibroid Embolization
What are fibroid tumors?
Uterine fibroids are the most common tumors of the female genital tract. You might hear them referred to as "fibroids" or by several other names, including leiomyoma, leiomyomata, myoma and fibromyoma. Fibroids are noncancerous (benign) growths that develop in the muscular wall of the uterus. While fibroids do not always cause symptoms, their size and location can lead to problems for some women, including pain and heavy bleeding.
The symptoms that can be associated with fibroids are: increase menstrual flow (heavy menstrual bleeding and the passing of clots), pain, pressure, heaviness and discomfort. Other symptoms associated with fibroid tumors may include urinary urgency and frequency, constipation and discomfort during sexual intercourse.
Your gynecologist probably has discussed many of the treatment options with you. Five of the options are discuss below:
- A myomectomy is the surgical removal of the fibroids but not the uterus. The procedure is often done for women who still want to have children. A hysterectomy is still frequently required following a myomectomy
- A hysterectomy is the surgical removal of the uterus. The woman becomes unable to have children after a hysterectomy.
- There are several hormonal therapies available. The hormonal therapy can decrease the symptoms and the tumor size. However, rapid regrowth of the fibroids usually occurs when the hormone therapy is stopped.
- Uterine fibroid embolization is a non-surgical treatment that causes fibroids to shrink by selectively blocking the arteries supplying blood to the fibroids. This procedure has only been done for fibroids since 1991. Normal term pregnancies and births have occurred following uterine artery embolization. However, the affects of the procedure on the ability to become pregnant and have a normal pregnancy is not known. Therefore, most physicians recommend against future pregnancies after the embolization procedure. Having made this statement, a few women who have been told that they could not become pregnant because of the fibroids, have become pregnant after the embolization procedure. Therefore, we recommend that you have “protected” sex following the procedure.
- Do Nothing. You and your doctor decide that your symptoms are not related to the fibroids or that you can tolerate your symptoms.
Fibroid embolization is usually done in a hospital by an interventional radiologist, a physician who is specially trained to perform this and other minimally invasive procedures. The interventional radiologist makes a small nick in the skin (less than one-quarter of an inch) at the crease at the top of the leg to access the femoral artery, and inserts a tiny tube (catheter) into the artery. The catheter is moved into the uterine artery at a point where it divides into the multiple vessels supplying blood to the fibroids.
The interventional radiologist slowly injects tiny plastic or gelatin sponge particles the size of grains of sand into the vessels. The particles flow to the fibroids first, wedge in the vessels and cannot travel to other parts of the body. Over several minutes, the arteries are slowly blocked. The embolization is continued until there is nearly complete blockage of the blood flow in the vessel. The procedure is then repeated on the other side so the blood supply is blocked in both the right and left uterine arteries.
As a result of the restricted blood flow, the tumor (or tumors) begins to shrink.
Patients with fibroids and associated symptoms are potential candidates for the embolization procedure.
Patients with chronic salpingitis or other chronic pelvic infections are not candidates for the procedure. Patients with a suspected cancerous tumor of the uterus, cervix, or ovaries should not undergo the procedure until the concern for cancer has been resolved. Your gynecologist may want to do a D&C or look into your uterus or abdomen with a scope to verify the absence or presence of cancer.
Each patient is different. Thus, the response to the embolization procedure will be variable. In general, the patients who have undergone the embolization procedure have reported favorable results. A breakdown of the results is as follows:
- The average decrease in the size of the fibroids has been 50% at 6 months.
- 85% of patients experience a significant decrease in pain. Very few patients have noted complete resolution of pain.
- 90% of patients cited a significant decrease in the menstrual bleeding
Uterine fibroid embolization has been performed since 1991, with the majority of the procedures being performed since 1994. As of November 1999, there has been no report of regrowth of the uterine fibroids.
Most patients resume their menstrual period with the next scheduled cycle. The initial menstrual period may be different, but after 2-3 cycles, the menses will become more regular. Most patient’s experience less flow, pain, and discomfort with their menstrual period.
The complications associated with the embolization are infrequent, but the most common ones include:
- Bleeding from the puncture site where the small tube is inserted. When bleeding does occur, it is usually easily controlled. Significant bleeding is quite rare.
- About 1% of patients develop a pelvic infection that results in the need for a hysterectomy. The infection is usually the result of the presence of an unsuspected infection in the tubes or uterus prior to the procedure.
- Painful urination (the arteries which supply the fibroids can sometimes supply a portion of the bladder), this can occur but usually resolves within 1-2 weeks.
- Your gynecologist will perform a baseline pelvic exam (usually within 1 month of the scheduled procedure).
- An ultrasound of the pelvis will be performed to determine the size and number of fibroids. The ultrasound will be done at UVa.
- A D&C or scope procedure may need to be done if there is concern for cancer in the uterus, or ovaries.
- Blood work and an ECG will be done the day of the procedure or within 1 week of the procedure.
- You will meet with one of the physicians in Angiography/Interventional Radiology (Special Procedures) to discuss the procedure and complete a brief history and physical exam, and sign an informed consent form.
Currently the literature recommends scheduling the procedure within one week after the end of your menstrual period.
You will come to the hospital the day of the procedure and can expect to stay 1-2 days.
The procedure usually takes 2-4 hours.
You should not eat any solid food after midnight prior to the day of the procedure. You can have clear liquids the morning of the procedure. If you are diabetic or take other medications on a regular basis let us know so that we can adjust your medications as necessary.
Most medications do not need to be stopped or held because of the procedure. However medications such as glucophage, coumadin, and insulin sometimes do need to be adjusted. Glucophage should not be taken for 2 days prior to the procedure. Coumadin is usually held 3 days before the procedure. High blood pressure medications usually are not held. The insulin dose is one half the regular morning dose. If you have an allergy to contrast dye (IVP dye or x-ray dye), please let us know so that we can prescribe a medication to reduce your risk of a "dye" reaction.
Angiography/Interventional Radiology is located on the second floor of the new hospital in the East Wing at the University of Virginia in Charlottesville.
Upon your arrival in the department, a nurse will accompany you to the recovery area. The nurse will help you change into a hospital gown and then start an IV line. Any necessary blood work will be done. The IV allows us to give you medications to help you relax and decrease any discomfort that you may have during the procedure.
A physician will meet with you to complete your history and physical, explain the procedure and ask you to sign an informed consent form.
The nurse and X-ray tech will take you to a special procedure suite where the embolization will be performed. After placing you on the x-ray table, your groin areas will be cleaned with a special soap and you will be covered with sterile drapes. A physician will numb the area of your groin and insert a small needle into your artery. A small tube, called a catheter, will then be inserted into the artery in your groin. The catheter will be positioned to allow us to see the arteries supplying your uterus and fibroids. Pictures will be taken using a small amount of contrast dye. After the physician has located the arteries to be blocked, he/she will inject a Styrofoam-type material into the arteries, blocking the blood supply to the fibroids. Once the physician has blocked the arteries, you will be returned to the recovery room. The catheter in your groin will be removed and pressure placed on the artery in your groin. You will be observed for a brief period of time in the recovery room before going to your regular hospital room.
You will be admitted to a bed on a regular nursing unit where someone will monitor your blood pressure, heart rate, temperature and pulses at frequent intervals. They will also check the puncture site in your groin area for any signs of bleeding or bruising. You will also receive instructions on what to do if you have to cough, sneeze or vomit.
You will be on strict bedrest at least 6 hours after the procedure. After that time, the head of your bed can be raised slightly. You should not get out of bed until 8:00 A.M., the day after the procedure. The day after the procedure you can get out of bed, but you should take it easy.
Some patients complain of cramping and pain in the pelvic area and nausea after the procedure. The doctors will order a pain medicine that can be given to you in your IV. The pain usually decreases over the next 24-48 hours. Before going home, the physician will change the medications to a medicine that you can take by mouth. It is not uncommon for you to have "flu-like’ symptoms for 5-7 days after the procedure. Mild fever, nausea, aching and pain can usually be managed with medications. Most patients are able to resume sedentary work within 5-7 days.
Some patients experience "flu-like" symptoms after the embolization. The symptoms go away over a period of 5-7 days, although mild symptoms may linger on for up to 2 weeks. However you need to contact us or your gynecologist for:
- A temperature greater than 101 degrees and /or chills;
- Persistent pain not relieved by the prescribed pain medication; or
- Persistent nausea and vomiting.
If you notice bleeding or a bruise growing around the puncture site in your groin, call Angiography/Interventional Radiology (Special Procedures) at 1-434-924-9401 between 8:00 A.M. and 5:00 P. M. and ask for the physician on call. Between 5:00 P.M. and 8:00 A. M., call 1-434-924-9400 and ask for the physician on call for Special Procedures. Please give the operator your name and home phone number. Otherwise, you should call an ambulance and go to the nearest Emergency Room.
Currently we are requesting patients have the following follow-up:
- A pelvic ultrasound done at UVa at 6 weeks, 6 months, and 1 year;
- A pelvic exam by your gynecologist at 6 weeks, 6 months, and 1 year;
- Other exams at the discretion of your gynecologist; and
- Completion of a telephone questionnaire at 6 weeks, 6 months, and 1 year.
Most patients are able to resume sedentary work within 5-7 days.
For any questions or concerns:
Contact the Radiology and Medical Imaging department at 434-924-9400.